Monday, 17 November 2025

SLO1 Care for Physiologically Stable Adult Patients

 


Achieving RCEM Specialty Learning Outcome 1: Care for Physiologically Stable Adult Patients



Executive Summary

Specialty Learning Outcome (SLO) 1, "Care for physiologically stable adult patients presenting to acute care across the full range of complexity," represents the fundamental building block of clinical practice in Emergency Medicine (EM) (1). Mastery of this SLO is essential for trainees at all levels and forms the basis for all other clinical learning outcomes. The purpose of the Royal College of Emergency Medicine (RCEM) curriculum is to train consultants capable of providing urgent and emergency care to all undifferentiated patients, a demand which is increasing annually, particularly among older patients with complex co-morbidities (2).

Achieving SLO 1 requires the development of expertise in history taking, clinical examination, decision-making, and the management of individual adult patients. This capability must be applied across the full spectrum of presentations, including physical and mental health problems, complex co-morbidities, and frailty syndromes (1).

Key strategies for developing and demonstrating competence include:

  • Mastering the Consultation: Utilising structured consultation models, such as the Calgary-Cambridge Guide, to ensure a patient-centred approach that identifies ideas, concerns, and expectations (ICE) (3). This includes proficiency in non-verbal communication, which is critical for building rapport and is often more impactful than verbal communication (4).
  • Adopting Evidence-Based Clinical Practice: Grounding clinical examination and diagnostic reasoning in evidence-based resources to improve accuracy and clinical significance (5).
  • Embracing Cultural Safety: Moving beyond basic cultural competency to a framework of cultural safety. This requires a paradigm shift towards critical self-reflection on one's own biases, privileges, and the inherent power imbalances in the clinician-patient relationship, allowing the patient to define what constitutes a safe clinical encounter (6, 7).
  • Evidencing Progression: Systematically collecting evidence through a range of Workplace-Based Assessments (WPBAs), such as ACATs, CbDs, and Mini-CEXs, across a diverse case mix. Competence is summatively assessed through RCEM examinations and formal entrustment decisions at the end of Core, Intermediate, and Higher training stages (1).

This document provides a comprehensive synthesis of the curriculum requirements and best practices to guide EM trainees in successfully achieving SLO 1.

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1.0 Understanding SLO 1: Specification and Progression

1.1 Definition and Scope

SLO 1 is defined by the RCEM as the basic building block for patient care within the Emergency Department (ED). It encompasses the development of expertise in history taking, examination, decision-making, and management for individual adult patients. The scope is comprehensive, covering all physiologically stable adult patients across the full range of complexity. By the completion of training, an EM specialist is expected to be an expert in this SLO (1).

This expertise explicitly includes a deep understanding and aptitude in caring for specific patient groups who frequently present with complex needs (1):

  • Patients with mental health problems.
  • Patients with complex co-morbidities.
  • Patients with frailty needs.

1.2 Progression Through Training

The curriculum outlines a progressive development of capabilities. Trainees are expected to demonstrate increasing levels of autonomy and expertise as they advance through the stages of training (1).

Training Stage

Key Capabilities

Level of Supervision

ACCS (Core)

• Gather appropriate information, perform a relevant clinical examination, and formulate a management plan that prioritises patient choice.<br>• Know when to seek help.<br>• Assess and plan for patients with complex medical and social needs.

Direct supervision available. Trainee knows limitations and when to seek help.

Intermediate

• Assess and manage all adult patients attending the ED.<br>• Formulate management plans for patients with complex medical/social needs or frailty syndromes.

Supervisor "on call" from home, available via phone and able to attend the bedside if required.

Higher (HST)

• Be an expert in assessing and managing all adult patients attending the ED.

Able to manage with no supervisor involvement.

1.3 Key Descriptors for Mastery

To achieve SLO 1, trainees must demonstrate proficiency across several domains. These descriptors provide a detailed framework for the knowledge, skills, and behaviours required (1).

Core Clinical Skills (ACCS Level):

  • Demonstrate professional behaviour and deliver patient-centred care with shared decision-making.
  • Take a relevant history, incorporating patient symptoms, concerns, priorities, and preferences.
  • Perform accurate clinical examinations and demonstrate appropriate clinical reasoning.
  • Formulate a differential diagnosis and a corresponding management plan.
  • Explain clinical reasoning to patients, carers, and colleagues.
  • Select, manage, and interpret investigations appropriately.
  • Recognise the need for specialty liaison and demonstrate awareness of the needs of vulnerable adults.

Mental Health Presentations:

  • Assess and manage patients presenting with features of mental illness, including a competent assessment of suicide risk.
  • Professionally and compassionately assess a patient in crisis and safely manage acutely disturbed behaviour.
  • Work collaboratively with Psychiatry Liaison, Police, and other agencies.
  • Understand safeguarding responsibilities and the legal frameworks relevant to the ED.
  • Respect patient autonomy while understanding best-interest decisions for patients lacking capacity.

Older Patients with Frailty and Complex Co-morbidity:

  • Interact effectively with frail older people, especially those with cognitive impairment, and their families.
  • Assess for frailty syndromes (falls, immobility, incontinence, polypharmacy, delirium).
  • Recognise physiological pitfalls in the assessment of frail older people (e.g., in trauma).
  • Be aware of safeguarding issues, pharmacokinetics in frailty, and the medicolegal framework for managing patients with cognitive impairment.

Observational Medicine:

  • Evaluate patients in a Clinical Decision Unit (CDU) or observational setting.
  • Estimate risk, utilise diagnostic tests appropriately, and formulate safe discharge plans.
  • Communicate effectively with patients in this setting.

2.0 Core Components of Patient Care: A Practical Approach

2.1 Mastering the Consultation

The consultation is described by Pendleton as "the central act of medicine" and is the fundamental tool of practice (3). Effective consultation skills are learnable and can be honed through analysis and reflection.

2.1.1 Aims and Models of Consultation

A good consultation achieves multiple objectives. The model developed by Pendleton and colleagues outlines seven key tasks (3):

  1. Define the reason for attendance, including the patient's ideas, concerns, expectations (ICE), and the effects of the problem.
  2. Consider other problems, including continuing issues and opportunities for health promotion.
  3. Choose an appropriate action based on sound clinical management.
  4. Achieve a shared understanding with the patient regarding their condition and management.
  5. Involve the patient in management to encourage shared responsibility.
  6. Use time and resources appropriately.
  7. Establish or maintain a positive doctor-patient relationship.

Numerous models exist to structure the consultation. The Calgary-Cambridge Guide is an evidence-based approach widely used in UK medical schools. It divides the consultation into five stages: initiating the session, gathering information, building the relationship, explanation and planning, and closing the session (3).

2.1.2 The Power of Non-Verbal Communication

Non-verbal communication is a critical component of the consultation, often communicating more about attitudes and emotions than words. When verbal and non-verbal messages are contradictory, the non-verbal message tends to override the verbal one (4). Key elements include:

  • Eye Contact: Establishes rapport and influences what a patient reveals.
  • Posture and Position: An open posture can encourage communication.
  • Tone of Voice: A doctor's tone can signal interest or disinterest and is associated with patient satisfaction and even malpractice claim history (4, 8).

A significant modern challenge to effective non-verbal communication is the extensive use of computers in the consultation. Loss of eye contact while interacting with a screen can decrease patient fluency and increase the risk of missing vital information. Heath recommends several strategies to mitigate this (4):

  • Postpone: Deliberately delay using the computer until the patient has completed their opening statement.
  • Wait: Use opportune moments (e.g., when the patient is thinking) to look at the screen.
  • Signpost (Structure): Verbally signal your intention to look at the records and when you have finished, ensuring the patient understands the process.

2.2 Evidence-Based Clinical Examination

SLO 1 requires the ability to perform accurate clinical examinations and show appropriate clinical reasoning (1). To move beyond rote performance, trainees should focus on the evidence base underpinning physical diagnosis. The following resources are recommended for improving understanding of the usefulness and clinical significance of examination findings (5):

  • JAMA's "The Rational Clinical Examination" series: A collection of systematic reviews on the evidence-based use of history and physical examination (9).
  • "Evidence-Based Physical Diagnosis" (Steven McGee): A key text for understanding the diagnostic power of clinical findings.
  • Stanford 25: A resource for revising and refining basic examination skills (5).

2.3 Clinical Reasoning, Management, and Safety-Netting

A rational clerking template should be used to synthesise information efficiently. Crucially, the "Impression and Plan" section must clearly articulate clinical reasoning and thought processes, serving both clinical and medico-legal purposes (5).

Safety-netting is a critical skill described in Roger Neighbour's consultation model and is essential for safe discharge planning (3, 10). It involves asking key questions and providing patients with clear advice (3):

  • What do I expect to happen if I am right?
  • How will I know if I am wrong?
  • What would I do then?

The answers inform the advice given to patients about when and why to return to the ED (10).

3.0 Addressing Complexity: Cultural Safety and Vulnerable Populations

3.1 From Cultural Competency to Cultural Safety

Caring for patients across the "full range of complexity" requires more than just clinical knowledge; it demands an advanced understanding of how cultural and social factors impact the clinical encounter. The traditional model of "cultural competence"—acquiring knowledge about other cultures—is now considered limited and potentially harmful. It can lead to stereotyping, "othering," and a failure to address the core drivers of health inequity (6, 7).

As illustrated in a case vignette, stereotyping a Hispanic female patient as "histrionic" can lead a physician to misdiagnose an acute coronary syndrome as anxiety (7). This highlights the danger of provider bias.

A more effective framework is Cultural Safety. This represents a paradigm shift with the following core principles (6):

  • Focus on Power: It acknowledges the inherent power imbalance between clinician and patient.
  • Focus on Self: It requires the health professional to critically self-reflect on their own culture, biases, assumptions, and privileges.
  • Focus on the Patient's Experience: The patient, not the provider, determines if a clinical encounter is culturally safe.
  • Focus on Equity: The ultimate goal is to reduce bias, improve the quality of care, and achieve health equity.

The following mnemonic, REFLECT, can serve as a tool for practising cultural safety:

  • Recognise power imbalances in the clinical encounter.
  • Examine your own biases, assumptions, and privileges.
  • Foster trust through empathy and respect.
  • Listen to and validate the patient's unique experience.
  • Empower the patient to define what makes them feel safe.
  • Critically and continuously self-assess your practice.
  • Take action to challenge inequities within the healthcare system.

3.2 Practical Application in the ED

Applying cultural safety involves concrete actions. A proposed three-step paradigm to reduce disparities includes (7):

  1. Reduce Provider Bias and Increase Cultural Awareness: Actively work to limit the influence of stereotypes in clinical encounters.
  2. Clinically Accommodate Patients: Modify practices based on patient values and needs. This can involve using professional interpreters, respecting preferences for same-gender providers where possible, and engaging in clinical negotiation (7, 10).
  3. Promote Workforce Diversity: A diverse workforce enhances cultural awareness and may lead to more effective patient-doctor relationships (7).

These principles align with the RCEM's Best Practice Guideline on Patient Care, which recommends fundamental standards such as warmly greeting patients, introducing oneself by name and role, and using a patient's preferred name (10).

3.3 Specific Vulnerable Populations

The principles of patient-centred care and cultural safety are paramount when caring for patients with mental health conditions and frail older adults. For patients with suspected delirium or cognitive impairment, validated tools such as the 4AT score should be used for screening (5). The approach to these patients must be compassionate, holistic, and attuned to their specific vulnerabilities and complex needs (1).

4.0 Evidencing Competence for SLO 1

4.1 Programme of Learning

Trainees should engage in a variety of learning activities to develop the capabilities for SLO 1, including (1):

  • RCEM Learning modules, podcasts, and blogs mapped to the EM syllabus.
  • Local teaching programmes.
  • Simulation exercises, particularly for developing skills in dealing with distressed patients and relatives.

4.2 Workplace-Based Assessments (WPBAs)

Demonstrating competence requires a portfolio of evidence from WPBAs. Trainees are expected to seek feedback on their care on most shifts, especially for challenging cases involving clinical uncertainty, communication barriers, or complex co-morbidities (1). Key assessment tools include (1, 5):

  • Acute Care Assessment Tool (ACAT)
  • Case-Based Discussion (CbD)
  • Educational Supervisor’s Led End of Placement evaluation (ESLE)
  • Mini-Clinical Evaluation Exercise (Mini-CEX)
  • Multi-Source Feedback (MSF)
  • Logbook of cases

4.3 Summative Assessment and Entrustment

Summative assessment for SLO 1 is achieved through successful completion of RCEM examinations (MRCEM and FRCEM). The culmination of training is a series of entrustment decisions, where the trainee is trusted to perform independently at the level required for each stage (1).

Level of Entrustment

Training Stage

Description of Entrustment

Level 2b

End of Core Training (ACCS)

Entrusted to evaluate a stable patient, formulate a differential diagnosis including a worst-case scenario, and create a management plan. Entrusted to interpret key investigations (ECG, plain radiography) and know their limitations.

Level 3

End of Intermediate Training

Entrusted to evaluate any physiologically stable patient and formulate a safe management plan in all but the most complex cases, with senior support available remotely.

Level 4

End of Higher Training (HST)

Entrusted to evaluate any physiologically stable patient and formulate an expert management plan independently. Able to support others and act as a role model.

References

  1. Royal College of Emergency Medicine. SLO 1 – Care for physiologically stable adult patients presenting to acute care across the full range of complexity. RCEMCurriculum [Internet]. 2019 Jan 28 [cited 2025 Nov 13]. Available from: [Source URL]
  2. Royal College of Emergency Medicine. Purpose Statement. RCEMCurriculum [Internet]. 2019 Jun 18 [cited 2025 Nov 13]. Available from: [Source URL]
  3. Vincent P. Consultation analysis. Patient.info [Internet]. 2025 Mar 14 [cited 2025 Nov 13]. Available from: [Source URL]
  4. Silverman J, Kinnersley P. Doctors' non-verbal behaviour in consultations: look at the patient before you look at the computer. Br J Gen Pract. 2010 Feb 1;60(571):76–78.
  5. Anonymous. SLO 1. Care for physiologically stable adult patients presenting to acute care across the full range of complexity [Educational Handout]. [place unknown]: [publisher unknown]; [date unknown].
  6. Curtis E, Jones R, Tipene-Leach D, Walker C, Loring B, Paine S-J, et al. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int J Equity Health. 2019 Nov 14;18(1):174.
  7. Padela AI, Punekar IRA. Emergency Medical Practice: Advancing Cultural Competence and Reducing Health Care Disparities. Acad Emerg Med. 2009;16(1):69–75.
  8. Ambady N, Laplante D, Nguyen T, Rosenthal R, Chaumeton N, Levinson W. Surgeons' tone of voice: a clue to malpractice history. Surgery. 2002 Jul;132(1):5–9.
  9. JAMA Network. The Rational Clinical Examination [Internet]. Chicago, IL: American Medical Association; 2025 [cited 2025 Nov 13]. Available from: https://jamanetwork.com/collections/6 Rational Clinical Examination
  10. Royal College of Emergency Medicine. Patient Care in the ED. Best Practice Guideline. London: RCEM; 2021 Nov.
  11. Royal College of Emergency Medicine. SLO 1 Archives. RCEMLearning [Internet]. [place unknown]: RCEM; 2025 [cited 2025 Nov 13]. Available from: [Source URL]


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2.1 Achieving RCEM SLO 1: Care for Physiologically Stable Adult Patients


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Friday, 14 November 2025

Best Practice Guideline on Patient Care in the ED

 


Briefing: RCEM Best Practice Guideline on Patient Care in the Emergency Department



Executive Summary

This briefing document synthesizes the November 2021 Royal College of Emergency Medicine (RCEM) Best Practice Guideline on Patient Care in the Emergency Department (ED). The guideline was developed in response to key inquiries, including the Francis Report (1), to re-emphasise a culture where a safe, committed, compassionate, and caring service is paramount, shifting focus from purely target-based metrics. It serves as a comprehensive checklist for medical and nursing staff to benchmark, audit, and improve patient experience and quality of care.

The standards are categorised into two levels:

  • Fundamental (F): Standards that every Emergency Department should routinely achieve.
  • Developmental (D): Standards that departments should be actively working towards.

The guideline is structured around four core themes: the patient environment, the patient pathway (from arrival to discharge), care for specific patient groups, and departmental/staff requirements. Key takeaways include the critical importance of effective communication at every stage, maintaining patient dignity and privacy, proactive symptom management, and fostering a supportive and well-led departmental culture that values staff wellbeing. Departments are expected to use this document for regular self-assessment and to escalate any standards that cannot be met to ensure appropriate action is taken.

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1. The Patient Environment: Core Standards

The physical environment of the ED profoundly impacts patient perception and experience. The guideline stresses that a clean, well-maintained, and dignified setting is a fundamental aspect of care.

  • Cleanliness and Condition (Fundamental): All areas of the ED, including waiting rooms and entrances, must be clean and well-lit. The physical state of the department should be in good order, as poor maintenance (e.g., stained ceiling tiles) can negatively affect patient confidence in the quality of their clinical care. Toilet facilities must display a completed daily cleaning log, with cleaning recommended at least twice daily.
  • Navigation and Information (Fundamental): Signage must be sufficient to enable easy navigation. The ED can be disorienting, and clear information about the patient "pathway" is essential.
  • Privacy and Dignity (Fundamental): Clinical areas must be designed to protect patient privacy. This includes preventing sensitive questions or clinical handovers from being overheard and providing a securable, private cubicle (with solid walls, not curtains) for intimate examinations, religious observance, or end-of-life care.
  • Waiting Area Provisions:
    • Fundamental: The waiting area should be furnished with reading materials and a television (e.g., a silent news channel).
    • Developmental: Departments should work towards providing WiFi access, clear information about the ED process (e.g., triage, the four-hour target), updated waiting times, and refreshments (with planning for patients who may need to be 'Nil by Mouth').
  • Support for Relatives and Carers:
    • Fundamental: Sufficient seating must be available in cubicles for relatives and carers.
    • Developmental: Patients should be informed they can use their phones, and a bank of phone chargers should be available. Staff should establish and meet patient wishes regarding communication with relatives. Refreshments should be offered regularly to relatives, and bereaved relatives should be routinely offered a follow-up appointment with a senior ED physician.
  • Patient Feedback (Fundamental): A robust system must be in place to seek, act upon, and share patient feedback (both positive and negative) with staff. This can be achieved through channels like the Friends and Family Test, care rounds (5), a monthly care newsletter, or involving Lay Representatives in departmental meetings.
  • Specialised Environments:
    • Psychiatric Assessment (Fundamental): A dedicated psychiatric assessment room conforming to PLAN (Psychiatric Liaison Accreditation Network) standards is required (4).
    • End-of-Life Care (Fundamental): In the event of a dying or recently deceased patient, the clinical area must be quiet and private. A laminated symbol (e.g., a butterfly) can be used to discreetly indicate the need for staff to maintain an appropriate atmosphere (Developmental).

2. The Patient Pathway Through the ED

The guideline provides a structured approach to the patient journey, emphasising communication, early intervention, and continuity of care.

2.1 Arrival

  • Warm Greeting (Fundamental): All patients, regardless of arrival method, must be warmly greeted by a named person. The "#CallMe" initiative is highlighted, encouraging staff to use a patient's preferred name.
  • Staff Introduction (Fundamental): All staff must introduce themselves by name and role, clearly stating the reason for the interaction (e.g., "I am here to take your blood pressure").
  • Process Explanation (Fundamental): The patient journey and departmental processes must be explained clearly, using various formats (posters, written materials, displays). Patients must be told how to access staff for needs or concerns, and call bells should be placed within reach.

2.2 Early Assessment

  • Senior Access (Fundamental): Nursing staff at patient entrances must have timely access to a senior doctor for managing critically ill patients and prescribing analgesia for severe pain.
  • Forecasting (Fundamental): Patients should be given clear "forecasts" about their expected care pathway, investigations, and timeline. For example, "You’re likely to have broken your hip...and will need surgery tomorrow..."
  • Time-Critical Conditions (Fundamental): An early and effective process must be in place for both the identification (e.g., using NEWS2) and rapid treatment of time-critical conditions such as Trauma, Sepsis, Stroke, and Myocardial Infarction.
  • Early Symptom Treatment (Fundamental): Symptoms such as pain, nausea, vertigo, and urinary retention must be treated early.
  • Patient Preferences (Fundamental): Patient expectations, previous decisions (e.g., DNAR/RESPECT forms, accessible electronically), and bespoke care needs (dietary, language, religious) must be established early in the visit.

2.3 Assessment and Diagnosis

  • Regular Reviews (Fundamental): Patients require regular reviews to check on comfort, clinical status (to identify deterioration), and the effectiveness of treatments. This should be documented.
  • Regular Updates (Developmental): New information, such as test results or changes in the care plan, should be communicated to the patient and relatives in a timely fashion.

2.4 Continuing and Ongoing Care

  • Comfort Rounding (Fundamental): Comfort rounds should be routine, and pillows should be offered to patients likely to be admitted.
  • Amenities (Developmental): A trolley round offering food, drink, and toiletries, potentially run by volunteers, should be considered.
  • Practical Information (Developmental): The department should display up-to-date information on taxis, public transport, and local amenities.
  • Translation Services (Developmental): Easy access to translation services, including British Sign Language (BSL), should be available.

2.5 Discharge

  • Comprehensive Discharge Planning (Fundamental): A discharge checklist should be used by all staff. Planning must include:
    • Bespoke verbal and written advice.
    • "Safety netting" advice on when to return.
    • Information on fitness to drive/work.
    • Clear explanation of the diagnosis (and any uncertainty).
    • A check of social and welfare concerns.
    • Communication of the plan to carers and other healthcare providers.
  • Follow-Up and Prescriptions (Fundamental): Follow-up appointments should be arranged before discharge where possible. If not, the process must be clear and robust. Prescriptions should be provided to avoid the patient needing to return.
  • Results Management (Fundamental): An effective system must exist for reviewing investigation results and communicating them to patients. This must cover delayed results (e.g., microbiology), addendums, and incidental findings.

3. Care for Specific Patient Groups

The guideline mandates tailored approaches for vulnerable patient populations.

3.1 Care of the Elderly Patient

  • Dementia Training (Fundamental): Dementia-friendly training is mandatory for all ED staff, including non-clinical personnel.
  • Dementia-Friendly Environment (Developmental): The department should be assessed by a group like the Alzheimer's Society. Standards include dementia-friendly toilets, clear signposting, and distraction therapies (e.g., twiddlemuffs).
  • Clinical Assessments (Fundamental): A skin vulnerability assessment must be performed on arrival for all frail, elderly patients. A falls prevention policy specific to the ED must also be in place.
  • Screening (Developmental): Routine screening for cognitive impairment is a developmental goal.
  • Guideline Adherence (Developmental): EDs should follow RCEM guidance on end-of-life care and the "Silver Book II" for quality care for older people.

3.2 Care of Children

  • Safeguarding (Fundamental): There must be demonstrable evidence of safeguarding children. All staff must be trained to the required levels, know the escalation process, and be able to identify the Trust safeguarding lead.
  • Distraction and Facilities (Fundamental/Developmental): Facilities for distracting distressed children (e.g., tablets, Starlight distraction boxes) are a fundamental standard. Meeting the full RCPCH standards for emergency care is a developmental goal.
  • Prompt Care (Fundamental): All children must be offered appropriate and prompt analgesia. Parents of children with vomiting and diarrhoea should be encouraged to start oral rehydration therapy upon arrival.

3.3 Patients with Complex Requirements

  • Learning Disabilities (Fundamental): The department must have and use access to learning disability healthcare staff.
  • Guideline Compliance (Fundamental): EDs must demonstrate compliance with a wide array of RCEM guidelines for managing patients with complex needs. This includes guidance on:
    • Absconding patients
    • Patients in police custody
    • Suspected internal drug traffickers
    • Sexual assault and rape
    • Domestic abuse (with availability of Independent Domestic Violence Advocates)
    • Mental Capacity Act and Acute Behavioural Disturbance
    • Homelessness, alcohol, and drug misuse
    • Frequent attenders (requiring multidisciplinary case management for very high-frequency attenders).

4. Departmental and Staff Requirements

A positive patient experience is underpinned by a well-supported, educated, and well-led ED team.

4.1 The ED Team and Wellbeing

  • Staff Value (Fundamental): All staff must feel valued. This can be achieved through sharing positive feedback, offering recognition (e.g., care awards), and senior staff thanking teams for their efforts. Support systems must be in place for those involved in stressful situations.
  • Teamwork (Fundamental): Regular, scheduled, combined medical and nursing handovers are essential for effective team collaboration.
  • Senior Support (Fundamental): Senior doctors must be approachable and available, with clear processes for juniors to contact them.
  • Staff Breaks (Fundamental): Staff must be routinely able to take breaks to prevent burnout and clinical errors.
  • Staff Wellbeing (Fundamental): The ED should have an active wellbeing champion and systems to prevent, identify, and support staff burnout.
  • Inter-specialty Support (Fundamental): Staff from other specialties working in the ED must be welcomed and supported.

4.2 Departmental Operations

  • Equipment (Fundamental): Equipment must be easy to locate, clearly organised, and re-stocked daily.
  • IT and Estates (Developmental): An effective process for reporting and responding to problems with IT, estates, and equipment is a developmental standard, with a nominated IT/Informatics lead recommended.

4.3 Education and Governance

  • Compassionate Care Training (Developmental): All staff should receive training in customer care and compassionate care.
  • Embedding Care Culture (Fundamental): "Care" must be a core component of ED induction and ongoing teaching for all staff.
  • Raising Concerns (Fundamental): Staff must be encouraged to report concerns regarding care and know the correct escalation procedure (e.g., line manager, Freedom to Speak Up Guardian).
  • Duty of Candour (Fundamental): Registered staff must be aware of their statutory obligation to observe a duty of candour when a patient has come to harm or death due to clinical error.

4.4 Measuring Care and Leadership

  • Quality Improvement (Developmental): The ED must demonstrate measurable improvements in care in response to CQC reports, audits, and patient feedback, and engage with national benchmarking projects.
  • Departmental Leads (Developmental): The department should have designated leads for care and for significant patient groups (e.g., dementia, frequent attenders).
  • Population Health (Developmental): The ED should understand the population it serves and tailor its services accordingly (e.g., providing access to HIV screening or frailty in-reach services based on local need).
  • Safety Culture (Fundamental): Safety must be embedded in the department's culture, processes, and structures, supported by a departmental risk register and clear policies on clinical responsibility.
  • Infection Prevention and Control (Fundamental): The department must demonstrate adherence to IPC guidelines through measures like hand hygiene audits and staff compliance with mandatory training.

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References

  1. Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry 2013. https://www.gov.uk/government/publications/reportof-the-mid-staffordshire-nhs-foundation-trustpublic-inquiry (accessed 28 March 2017)
  2. Robinson S, Brown R. The Francis Report: a call to arms. Emerg Med J 2013;30;783
  3. Berwick D. A promise to learn – a commitment to act. Improving the Safety of Patients in England 2013. https://www.gov.uk/government/publications/berwick-review-intopatient-safety (accessed 28 March 2017)
  4. Psychiatric Liaison Accreditation Network (Royal College of Psychiatrists). PLAN Standards. Available at: http://www.rcpsych.ac.uk/workinpsychiatry/qualityimprovement/ccqiprojects/liaisonpsychiatry/plan.aspx (accessed June 2017)
  5. Lloyd G. Care rounds: hot patient feedback enabling team care education. Br J Hosp Med 2016;77:262
  6. Lloyd G, Reuben A. Improved emergency department patient care via rapid assessment and triage. Br J Hosp Med 2017;78:500
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1.9 The ED Compassion Roadmap: RCEM Patient Care Standards in the ED


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Thursday, 13 November 2025

MEM-EM CONTENTS & Structure

 

MEM-EM CONTENTS/ STRUCTURE

The Zero Pont Survey was developed to provide organised and structured preparation for the very unwell patient quickly bringing together an ad-hoc team in the best environment to help optimal performance in caring for sick patients (medical & trauma). Reviewing the zero point survey video combined with the video making things happen is a great start into learning how to mange the resus room. The zero point is a useful structure both for preparing for sick patients but also for analysing cases to learn from and make improvements. It is encouraged that leaners read the paper view the video and consider STEPS used for analysis of cases. However, sometimes to understand cases we need to think about the strategy used and how we prioritise and set goals plan action and skills. 

The structure of this website loosely follows the STEP UPS structure with the second 'S' to represent systems and safety focused topics. Season 1 of the podcast covers the STEP UPS fundamentals of practice. Season 2 covers the SLOs and curriculum details. Season 3 Covers clinical topics and updates. Season 4 covers clinical debates and literature reviews. 
 

1. Fundamentals: Self, Team, Environment


SELF

Wellness in Emergency Medicine: Switch From Surviving To Thriving!


Keeping Up in EM: Suggested Educational Resources for Exam Preparation & Lifelong Learning.



TEAM

(It is fully acknowledged the vital importance of the nursing, HCA, porters, PFC and many others in the ED team but others are better qualified to provide their educational needs this is the only reason they are not included in the topics below). 



A Guide to Paediatric Emergency Medicine (PEM) Sub-Specialty Training for UK Emergency Medicine Doctors

Mapping the Emergency Practitioner (EP) Curriculum to the RCEM SLOs


ENVIRONMENT and Emergency Equipment/Drugs 





Facing the Future: Standards for children and young people in emergency care


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2. PATIENT and principles/SLOs 

   Pillar

• SLO #

•                Specialty Learning Outcome Description

• Comprehensive Clinical Care

•                1

•                Care for physiologically stable adult patients presenting to acute care across the full range of complexity.

•                3

•                Identify sick adult patients, be able to resuscitate and stabilise and know when it is appropriate to stop.

Manage patients with organ dysfunction and failure

•                4

•                Care for acutely injured patients across the full range of complexity.

Crisis Resource Management and human factors in Emergency Medicine 

Silver Trauma: Best Practice for Ax & Mx in the ED

•                5

•                Care for children of all ages in the ED, at all stages of development and children with complex needs.

A Guide to Paediatric Emergency Medicine Sub-Specialty Training for UK Emergency Medicine Doctors

•Procedural & Situational Management

•                6

•                Deliver key procedural skills.

Briefing on Invasive Procedures and Procedural Skills in the Emergency Department

Provide Anaesthetic Care & Sedation in ED

•                7

•                Deal with complex and challenging situations in the work place.


UPDATES / Utilise the team 

     Pillar

• SLO #

•                Specialty Learning Outcome Description



•Departmental Leadership & Management

•                8

•                Lead the ED shift.

Emergency Department Flow & Crowding: A Practical Guide to Escalation and Safety

•                12

•                Manage, Administer and Lead.


PRIORITISE and goals  


       Pillar

• SLO #

•                Specialty Learning Outcome Description


•Education & Professional Development

•                2

•                Support the ED team by answering clinical questions and making safe decisions.

•                9

•                Support, supervise and educate.





SYSTEMS and Safety 

 Pillar

• SLO #

•                Specialty Learning Outcome Description



•Education & Professional Development

•                10

•                Participate in research and managing data appropriately.

•                11

•                Participate in and promote activity to improve the quality and safety of patient care.

A How-To Guide for the RCEM QI Assessment




3. Clinical Topics & Practice Updates

RCEM Syllabus Summaries:


RESUS Overview

Clinical PresentationsCondition / Issues
RP1. Acute airway obstructionRC1. Choking
RP2. Anaphylaxis/Anaphylactoid reactionRC2. Stridor
RP3. Cardiorespiratory arrest
RC3. Organ donation
- The Dying Patient
RP4. Major Trauma

                Care for acutely injured patients across the full range of complexity.

Crisis Resource Management and human factors in Emergency Medicine 

Silver Trauma: Best Practice for Ax & Mx in the ED

See also the PTN PODCAST

General Concepts

Section 2.2 – System Injuries

RC4. BRUE
RP5. Respiratory failure
        		RC5. SUDIC Protocol
RP6. Sepsis
- NICE Sepsis Mx >16y
- NICE Sepsis Mx <16y
- NICE Sepsis in Pregnancy Mx 
RP7. Shock
RP8. Unconsciousness


 ** Whilst this section is under construction the excellent resources from CRACKCast following the chapters of Rosen's Emergency Medicine Textbook is recommended to aid your linear knowledge acquisition*** Quick links to relevant sections provided below: 

Part I – Fundamental Clinical Concepts

Section 1.1 – Critical Management Principles

Section 1.2 – Cardinal Presentations

Part II – Trauma


Section 2.3 – Orthopedic Lesions

Section 2.4 – Soft Tissue Injuries

Section 2.5 – Violence and Abuse

Part III – Medicine and Surgery

Section 3.1 – Head and Neck Disorders

Section 3.2 – Pulmonary System

Section 3.3 – Cardiac System

Section 3.4 – Vascular System

Section 3.5 – Gastrointestinal System

Section 3.6 – Genitourinary and Gynecologic Systems

Section 3.7 – Neurology

Section 3.8 – Psychiatry

Section 3.9 – Immunologic & Inflammatory

Section 3.10 – Hematology & Oncology

Section 3.11 – Metabolism and Endocrinology

Section 3.12 – Infectious Disease

Section 4.1 – Environment

Section 4.2 – Toxicology

Section 5.1 – The Paediatric Patient

Section 5.2 – The Pregnant Patient

Section 5.3 – The Geriatric Patient

Section 5.4 – Special Clinical Circumstances

Section 6.1 – Emergency Medical Services and Disaster Preparedness

Revised Episodes (9th Edition) 

Part 1: Critical Management Principles

Part 2: Signs, Symptoms and Presentations


4. Clinical Debate & Literature Reviews

CDR - Helping or Harming EM?




5. Mental Simulation/Visualisations

*** Whilst this section is under construction see the excellent LITFL, Procedures App and resus drills resources on practical procedures and mental simulation ****

4 Ways to Supercharge Your Mental Simulation and Visualization for Emergency Medicine and Beyond
LITFL Procedures 
Resus Drills EM3





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